Understanding Mental Health Parity with Deborah Steinberg

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next.

Welcome back everyone to the Mental Health Evolution Podcast where we are talking about how the landscape is quickly evolving in the mental health industry. And today we are talking to Deb Steinberg, who is the Senior Health Policy Attorney at the Legal Action center in Washington, D.C. where she advocates for state and federal policies to expand access to comprehensive and equitable safe substance use disorder and mental health care. Deb works in policy advocacy, which fits into the topic of all the changes in the mental health space. Currently she also co leads the Center's Medicare Addiction Parity Project, which is an initiative to expand Medicare's coverage of substance use disorder treatment and ensure the Parity act is applied to Medicare. As always, I want to give a little background here to set the stage for our conversation to our listeners so you all have some information about the topics that we are addressing. So here are some things that have been in the news recently. This article is called Mental Health Care May be Harder to Obtain after hhs, meaning the HHS Rule Reversal and that is from the Stat News link. This article talks through the original legislation, the Mental Health Parity and Addiction Equity act of 2008 and the law was supposed to prevent private insurance companies from instituting unequal coverage for mental health and physical health services. If you've listened on this pod before, we have talked about how sometimes there's unequal reimbursement rates for mental health care versus physical healthcare and that's kind of what we're talking about here. Instead, insurance companies found loopholes and in 2024 that the Department of Health and Human Services and two other federal agencies attempted to sew up these loopholes. But on May 9, three federal agencies, including HHS notified the judge that they will enforce companies to comply with the current regulations, including potentially modifying or rescinding the regulation. Short story, this means that insurance companies can continue to provide unequal coverage. And in another article, this one is from the ama, they are collaborating with the Kennedy Forum and Third Horizon to launch the Mental Health Parity Index, which is an index that creates transparency to see what is being reimbursed for medical doctors versus those providing mental health care. Specifically, the tool analyzes commercial insurance plans based on access coverage and payment for mental health and substance abuse services as compared with physical health services, using the transparency in coverage data published by Individual Insurance Plans. This is being piloted, by the way, in Illinois. They're piloting a lot of things advocacy wise, and so far data has shown about a 27% difference between payment to physicians who provide physical health care compared to physicians who deliver mental health care and substance use disorder care. And lastly, I want to highlight this article, this one happening in Georgia Commissioner King fine insurers over 20 million in mental health parity and this story is insurance and fire safety. Fire Commissioner John F. King announced today that he will fine health care insurance companies over $20 million for violating mental health parity laws, saying, I was there when Georgia's Mental Health Parity act was signed into law in 2022. Three years later, our initial examinations show that insurers have turned a blind eye to the rules and continue to deprive Georgians of the essential behavioral health resources they deserve, said Commissioner King. So I know that was a lot of information kind of updating you on where the parody laws are now and what's happening. But mental health and addiction parity laws do exist, but it seems like enforcement is somewhat questionable. Some people seem to be able to ignore those laws. And Deb, I'm really eager to hear some of your perspectives and updates on equity and also parity for provider protection in the field of mental health. So I want to start with a very basic can you explain what mental health parity truly means and why it's important?

Sure. Thank you. So mental health parity is an anti discrimination law, and it says that health insurance plans cannot discriminate against people with mental health conditions or substance use disorders. And essentially they have to cover mental health or substance use disorder care in a way that is comparable to how they cover medical care or surgical procedures. So without parity, people may have to pay more to see a mental health therapist than to see a physical therapist. Or they may have medications for opioid use disorder excluded from their health plan, even though their plan covers medications for the treatment of pain. Or residential treatment for an eating disorder might get cut off after seven days, but residential treatment for a physical injury may be permitted for 30. So parity is important because it ensures that people can get the mental health and substance use disorder treatment they need. It's important because mental health and substance use disorders our health conditions, so our health insurance needs to cover them in the same way it does for any other health condition.

That is incredibly helpful to understand. And the parity there really is medical versus mental health or substance abuse, and those should be equal. That's kind of what I'm hearing is the bottom line.

Exactly. It's really that comparison, because the parity law by itself does not actually require health plans to cover mental health care or substance use disorder care. The parity law just says that if you do cover those benefits, then the way you do it has to be equal. However, we also have the Affordable Care act, and the ACA says that mental health and substance use disorder benefits are essential health benefits. So when you have the laws together, they say that most plans do have to offer mental health and substance use disorder benefits, and then those benefits have to be comparable to medical care and surgical benefits.

Okay, that's really helpful. So what is exactly happening with this HHS rule reversal and how is this affecting people?

So it's a weird time. The rules were finalized in September of 2024. Okay. And then most of the rules that were part of this, like, giant rule were not even scheduled to go into effect until January 1, 2026. So we. We haven't even seen them go into effect yet. And then on January 17th of this year, 2025, a lawsuit was filed by the ERISA industry committee, or ERIC, that thought that these rules were too burdensome and too vague, but also too prescriptive and all of the things that made it impossible for these insurance plans to comply with providing equitable care. So obviously, that lawsuit was filed right before inauguration when a new administration was coming in, which newly heads up these agencies who had written the rules and also are responsible for defending the rules. So in this case, the agencies, when they responded to the lawsuit, they didn't respond to say, yes, we're going to defend the rules. We agree they're important. And said, they basically said, you know, actually, we're going to revisit these rules, so you don't even need to proceed with the lawsuit right now. So the lawsuit is on hold while they are going to revisit these regulations. And in the meantime, they've said that they are not going to enforce those 2024 regulations. So most of the rules hadn't even gone into effect yet. But at the same time, the regulations really reflected decades worth of efforts by advocates and regulators to really figure out the best way to oversee and enforce parity. They may not be perfect, but they really reflected a knowledge of the gaps that had been happening. They were closing the loopholes, but Also, in the meantime, there was a statutory change. The law actually changed a little bit back in 2020 that required health plans not only to just amorphously comply with the law, but actually to show their work, to perform and document a comparative analysis comparing mental health and substance use disorder benefits to medical benefits. So to show their work to prove that they comply with the law. So these regulations were also helping to implement that statutory change. They were saying, okay, here's how you do that analysis. And they were, like, giving kind of explanation and guidance. So without these regulations, plans still have to comply with that change. They still have to perform and document these analyses, but now they don't have the guidance for how to do it in a way that will allow regulators to review it in the same consistent way. So it's not only harmful for consumers and advocates who no longer have these stronger protections and closed loopholes, also problematic for the regulators and the plans who now don't have consistent information and structure for how they're supposed to actually comply with this law.

I mean, that just sounds very confusing to me. I mean, I understand everything that you just said, right. But what is underneath maybe that lawsuit and that desire to take away these regulations if there's already that 2020 mandate in place?

That is a great question. I think what we saw in the lawsuit was really sadly, an unwillingness to comply with parity. The kind of threat that was not even implicit, was quite explicit in the court filings, was that this was such an unworkable structure that plans would be unwilling to even offer mental health benefits. And rather than saying, like, hey, this is unworkable, but we actually do care about mental health and we want to make sure that people have the care that they need. Because this. These regulations, they came out of a, you know, notice and public comment process where consumers, the public, as well as the. The public insurance companies and the regulators, everyone was submitting comments, and those comments were taken into account, and the agencies came out with their interpretations of the law. And the health plans didn't like it because ultimately they would rather, apparently threatened to withhold mental health care from the public than provide it in a way that is equitable. So that was. That was really disheartening because I felt. I feel like the advocacy community has made a ton of progress in de. Stigmatizing these health conditions and making sure that they are as available and as accessible and as affordable to treat as other medical conditions. And seeing these, like large companies and employers that represent a large swath of the United States, say that they were unwilling to continue to comply with this law was. Was really devastating.

Well, and I'm kind of reading between the lines a little bit here, I guess, but to me, that's also maybe an acknowledgement of how different the pay is for mental health care. Right. Because if. If it's such a hardship to create parity for insurance companies, then that seems to indicate that there is such a huge discrepancy already that changing that would have a dramatic impact on their revenues.

It. That is definitely accurate. There is a great study that was conducted by RTI International that came out back in April of last year that really looks at some of those pay disparities for even the same codes when delivered by a mental health professional versus a physical health provider. And you can see how it plays out. They pay much less for those providers, and then patients have to go out of network more. So the cost just gets shifted back to the individual is the individual consumer is paying their premium, assuming they can get the care that they need. When they actually need mental health care, they're forced to go out of network because the health insurers are not paying those providers enough for them to be in network. And they're going to claim it's a shortage of providers. And don't get me wrong, there is absolutely a shortage of mental health providers that needs to be addressed. And also there are much starker shortages of other health providers that they've still. Still been able to figure this out for. And it's because you have to figure out what the strategies are to recruit enough providers to meet the network's needs. And sometimes that is financial incentives. Other times maybe it's reducing paperwork or burdens. They're ultimately taking those steps for the medical providers and not taking those steps for the mental health providers. But reimbursement is only one component of parity. Parity is also prior authorizations. It's also day limits. It's also coverage exclusions. So I think some of this is also recognizing that it's not just the reimbursement rates. It's all of those other barriers that health insurers are putting up that prevent people from getting treatment. And ultimately, if they have to do this whole comparative analysis, they might have to show that they are not actually complying with this law.

Yeah. And as the law was written, which I realize is in flux right now, what were some of the consequences for not complying? Or was that part of it or not?

So this is where it gets a little wonky. Parity is a little different for different types of health insurance. So the reason this was like three different agencies doing this rule together and then defending it is because each agency oversees a different type of plan. So with the Department of Labor, there is no explicit authority for the Department of Labor to. To fine health plans, whereas there is that kind of authority for a lot of states that are reviewing it. Which is why you pointed out these great fines that were just levied in Georgia. We've seen fines like that in a number of other states, though I will call out Georgia, because this was, I think, the largest fines I've seen for parity, which is really wonderful and also very sad that it's still remarkably low compared to the cost of doing business for these plans. But nonetheless. So you'll have kind of different state mechanisms for enforcement than you do for the federal government. And it's because the enforcement mechanisms aren't really tied to the parity law itself. They're tied to the agency that oversees them. But you can add in enforcement penalties when you're doing this kind of work, especially in states, if you're doing state advocacy. So what we saw in Georgia was Georgia put into their law. These are the fines not just for failing to comply with parity, but but also for failing to submit that, like, complete and sufficient analysis. So those are the kinds of things that really create some accountability and oversight in a way that's meaningful because that slap on the wrist isn't going to do it when they realize that the cost of doing business is, you know, maybe a different balance for them as compared to actually just complying with the law.

Yeah. It feels like there are just so many layers to this as we are talking, but I guess I am. I'm also curious. I don't know if you know the answer to this question, but it's popping up for me is how did we get to this place where there are such severe discrepancies between mental and physical health reimbursement rates?

Yeah, it's a really good question, and it's a saga that I will not tell the whole story of, but essentially it reflects how. How insurance was created in our country. And if you look all the way back to like the 1930s or wherever we were, I mean, insurance started more to deal with hospital situations. Right. And then as we were kind of building in some of the outpatient care and all that stuff, that was all happening at a time when we didn't really have community based mental health and substance use disorder care, we were institutionalizing folks, or we were putting them in jail Right. Like we were not doing a very good job of treating mental health conditions and substance use disorders. And so our insurance system was evolving at that time, and then now adding in the mental health and substance use disorder stuff, as those fields were evolving, they didn't feel the need to do it in a way that was equitable because that reflected the stigma and discrimination against those conditions. And now it's kind of making the insurance field catch up to where we've come with the science and making regulations catch up with science is. It's a challenge. It often is. And it's going to be slower than science evolves. But now we are here, now we know these are health conditions that need to be treated just as any other health conditions. And that's what parity is for. It's to root out that underlying discrimination that is still in our health plans. So if parity is done right, those, all of those underlying discriminatory barriers are supposed to go away. They're supposed to be corrected for. You wouldn't even need these fines because insurance would just be equitable. But unfortunately, we still have those underlying problems and new ones are being created every day. It's like whack a mole a lot of the time. But we have to keep trying because for every barrier we remove, we know that that is increasing systemic access to mental health and substance use disorder care. So that's why we keep fighting that. As lawyers and as advocates and policymakers, we know we can make insurance better and we're committed to doing so.

I love that. For the other argument, maybe I don't know this argument very well, but I'm hearing this piece of like, maybe insurance companies are coming forward and saying we, we literally can't afford to do this. What is your response to that?

Yeah, I think it is a concern that has been raised and never proven. As part of this notice in public comment period for these regulations, they asked questions, how much more would it cost you? Would it be a barrier? There's actually a provision in the law that says if it costs more than such and such percent of your, you know, plan's financing, then you don't have to comply. That's never been used. No one was able to show that this really was going to be, like, detrimental to their plan's financing, that they couldn't afford to do it. It's the threat that we always hear, but it's not what we've actually been able to see or demonstrate. So if you are a health plan who wants to make that argument, please show your work, because that is part of complying with the law. And you can be exempt from the law if you can show that this really is a financial barrier. But ultimately, what we all know is that by providing this access to mental health and substance use disorder in community based settings at a reasonable reimbursement rate, you're doing the same thing that we do with all other health conditions. You're making it so your consumers, the enrollees in the plan, can thrive, can live their best lives so that those conditions aren't exacerbating other health conditions. It's all about just creating this like equal playing field for people with these conditions to achieve health and well being. And ultimately we all know that actually leads to cost savings in the end, but it's a, it's a short term investment that needs to be made. But it's worth it for people with these conditions who deserve to live lives that are healthy and with dignity and where they can thrive.

Yeah, and to, to your point about that investment on the front end, I just think about all the aces work that's been done to show how much trauma impacts physical health. Right. Not just the two are not separate, they are very interrelated. And if you're treating trauma, if you're treating mental health, then you're also seeing benefits to physical health.

Absolutely.

Yeah. So from an advocacy perspective, what would you say are the greatest risks to good care out there? Just from a legislative perspective, maybe things that both impact people seeking care as well as providers themselves. What are you seeing?

Well, some of the like policies that we've been advocating for lately are really thinking through how to make sure that people can find providers that they need. Because oftentimes someone has their health directory from their plan that lists all the providers and maybe they're looking for an adolescent trauma specialist and they call everyone who's tagged as trauma or they call everyone who's tagged to adolescent, but there's no one at that intersection. Or maybe it's not even that specific. Maybe they're just trying to find a therapist who's within, you know, 20 miles of their house because they need to be able to drive there after work. Oftentimes you can't find that. And we know that that's a huge challenge for folks. And it's, it's part of several reasons. Maybe it's this like ghost network issue where a lot of those providers aren't actually in network anymore. Maybe they're no longer even alive at this point. And other times it's that the plan actually does have an inadequate network to meet your needs. And so there, there are solutions to problems like that. You can strengthen the network adequacy standards and make them specific enough that there are trauma specialists and there are eating disorder providers, like, not just one broad category of behavioral health, because we know those providers are not the same people, even though there are way too many misconceptions that they are. So you can do things like that. You can also require like secret shopper surveys, you know, making sure that someone's actually auditing those network directories to make sure they're accurate, to make sure that they are reflecting the network that's available to you so that it's not on the consumer to try and fail at 20 numbers only to feel like their condition isn't worth treating. Because that's the message that you get. You try all these numbers and just keep failing. And that's not right, and that's not fair. So been doing a lot of work on like that network adequacy side, do a lot of work on data collection as part of parity. We want to make sure that folks realize that parity isn't just about what's like written in your plan documents. You know, where it says like, yes, we require prior authorization for all medications. Okay, let's say that that's true. They require pre approval for every medication. But maybe the pre approval for the mental health medication takes like seven days to go through, whereas the health plan always gets the medical ones after one day. Or maybe all of the mental health ones come back and say, actually, I need you to try and fail at this cheaper medication first. Whereas all the medical ones let you get that one. Those are parity violations. But oftentimes you can't see those until you have the data. And so data collection is a very important part of parity. But it's one that has kind of not been as, as much of the center of attention. It's a little, it's a little bit more difficult. But it's so, so important because it shows what those real barriers are and it allows you to fix the root causes once you can identify the barriers. So we've been focusing on data collection, network adequacy. Another one is just the standards of care that health plans use sometimes, like their coverage criteria are not exactly based in science. They're based in how to preserve their profits. And so that's problematic when they're using different standards to decide what treatment as what the provider is using, who's thinking, what is the best care for My patient, what aligns with what I learned in my practice and through research and all this stuff. And your health plan is imposing different criteria. That means the patient can't get the treatment that they need. So there's another big effort that's really trying to align the coverage criteria that plans use with the standards of care that providers are using. So a lot of different efforts, some of which are parity with a capital P and some of which are parity adjacent, but all are leading to getting more equitable coverage of mental health and substance use disorder care.

Yeah. So how can people get involved with this if they're either a client, patient or a provider? What do you recommend?

A great question. So what I always recommend, first and foremost, if you are a patient or a provider, don't forget to submit complaints. And I know it's annoying and I hate telling people to do this when you don't have the assistance, especially if you're in a time of crisis. But if you get a denial or if you notice that your plan is reimbursing like a provider at a very, very low rate, submit a complaint both to the health plan and to the regulator of the health plan, which might be a state agency, it might be a federal agency. Either way it should be on any sort of denial notice or an adverse notice you get from your plan, you have to submit those complaints. And they don't have to be that detailed. Obviously it's better if they are. But flag that you think something is a parity violation and ask it to be investigated as a parody violation because that is how you can put that burden back on the plan. Because again, they have that requirement in law that they're supposed to perform and document that analysis, that comparison. Go ask for that analysis, make them send it to you, make them prove that they did their work and then flag it for the regulator because the regulator probably isn't going to investigate it unless it's raised to them. They, they don't know what they don't know. Right. So make sure you're raising this to the people who can do something about it. That is one very important thing. The other thing, get involved in some state based advocacy if you haven't already. A lot of states have, you know, different chapters of the like national organization. So there's like NAMI in every state. There's the American foundation for Suicide Prevention in all of the states. There's chapters of the provider associations like the American Psychiatric Association, Psychological association, social workers. There are all of these groups that are doing a lot of this state based advocacy already. Find out what sort of coalition they have or what their priorities are and see how you can help. There might be like a state capitol day where you can go and help advocate for some of these changes, get some of these laws in place in your state. Just do a little bit of googling, see what exists. Because they really do need the stories of people with lived experience. It's the best advocacy. It's really this combination of stories and data because you want to show that this is a systemic problem, that it's a huge barrier, but also put the face to it, show that these are real people. It's not just numbers that are being harmed. So it's that combination that can make a really big difference. And it means that even just one voice, your story, can make a difference and help us change some of these laws that still perpetuate this discrimination.

Yeah, I really like that. So I know that this conversation has been somewhat brief, but there has been so much content here. If there's something that you would just highlight or something that we didn't cover yet that you think is really important before we wrap up, what would that be?

Well, I, I know you had mentioned earlier about a Medicare proposed rule or a proposed bill, so I do want to flag that. When we've been talking about parity, I mentioned that it applies differently to different health plans. Well, it doesn't even apply to Medicare. So Medicare is the public health insurance for older adults, people 65 and older, as well as people with disabilities who are often unable to work. Medicare is not subject to parity, which means folks in Medicare, whether it's traditional Medicare or with like a Medicare Advantage plan, a private health plan that manages their Medicare, they can be subject to discrimination based on having mental health conditions. Their coverage is not equitable. So if there's one other issue that you want to tap into as an advocate, it's trying to help us get parity in Medicare and close some of the existing gaps that are still discriminatory in the Medicare program because mental health and substance use disorders still affect older adults. In fact, the rates are sometimes higher among older adults. Not necessarily the rates of the conditions, but some of the adverse outcomes. So even when the national overdose rate was decreasing, we still saw increases among older adults and suicide is very, very high among older adults. So these are really devastating outcomes that we can prevent if we have equitable access to coverage in Medicare. So strongly urge folks who care about this issue to help us advocate for better coverage in Medicare.

Can I ask the why question, why does it not apply to Medicare?

Oh, it's such a good question that I wish I knew a real answer to. Our best guess, having done this work for a while is just that it didn't even come up. It's not like we thought about adding parity to Medicare and someone was like, no, that's too complicated. Really. It was like when we were doing parity, the focus was on the workforce. It was, these were like a lot, mostly employer sponsored plans. Right. Because it was pre agency aca. So it was how do we get our employees the mental health care that they need? And so older adults wasn't even part of the conversation. And we added Medicaid and with the aca and we built it out enough, but now it's just this glaring gap that we don't have these protections in Medicare. And you know, we're optimistic now that the science has come far enough and there's enough evidence of how big bad the coverage is of substance use disorder mental health conditions. We published a report recently in Health affairs with RTI International. Again, you can tell I'm obsessed with their work. Yeah. So they, we just published a report on how low the quality of substance use disorder care is, just using process measures like how many people access treatment or how many people get follow up after an ED visit emergency department. So we, we can see that coverage needs to be improved. And hopefully we are like building the data case and that story bank to help get these kind of changes across the finish line to get folks the care that they deserve.

I so appreciate your level of knowledge and your ability to explain it in layman's terms to me and to our audience and, and just for your willingness to be here. So for everyone listening, you can find more information about Deb and her work in our show notes and we'll put links to articles and research noted there as well. And I just want to say thank you. Thank you so much for being here.

Thank you so much for having me.

Yeah. All right, that's a wrap for today everyone. Thanks for listening to the Mental Health Evolution podcast. And we will be back next week with more perspectives on our changing industry.

Recording stopped.

I feel like I could have kept talking to you. I was looking at the time going like, oh, tell me about it. So much, so much here.

Wow, there's a lot here.

I know and I love that you do a lot of work in Maryland and I would really love to figure out, I don't know if there's any way that you might be able to Tell me, like, with a group of providers that I have, you know, some influence in our community in Frederick, we focused a lot about how the tech industry is kind of honestly taking over what we're trying to do and some of the concerns with that. So I don't know if you have any suggestions about, but. But I know that, like, as that grassroots group of volunteers I was telling you about, like, we are all doing the work and trying to figure out how to advocate and where do we best pull the lever, you know what I'm saying, to make the most impact. So I would just be curious if you have any thoughts on that.

Yeah, well, I'm going to a planning retreat with a lot of other behavioral health advocates in the state at the beginning of next month, maybe in, like, two weeks. So that's where we're going to kind of work on our, like, agenda for the year. It's. It's a lovely coalition. The annoying part is that you have to pay dues to be a part of it. So it ends up being, like, mostly the bigger organizations. I mean, it's like $200, but that's still too much for, like, a private practitioner. They do exemptions, though, if you. Or exceptions, if that's something you're interested in. It ends up being a lot of lobbying, which, like, not everyone loves, but sometimes you can, like, just testify on a bill. And so, yeah, I mean, I try and send out emails to, like, this random coalition of people who have just asked me to email them so I can add you to that or add

any of your colleagues to that to the email. What is this?

Yeah, called. So the. The coalition that's doing a little planning thing is called the, like, Behavioral Health Coalition. It's run through the Mental Health association of Maryland. Okay. And so, like, a lot of the groups that are represented on it, like, their lobbyist is the person who shows up rather than the group themselves. But then the lobbyist will either, like, do their testimony for them or they'll, you know, find the right provider to make the case for them.

Interesting.

But, like, some of the folks that we've had testify in the past have just, like, when we're. When we've done, you know, parody legislation in Maryland, you know, it'll be like a random provider who sees the bill and reaches out and is like, hey, can I testify on this? We're like, yes, please. Like, how did you find bill? But great. And I think this year, what we're probably going to have to do because of how Maryland's laws are written. They. We do have state parity laws in Maryland that they reference federal regulations. And with these regulations potentially being rolled back like even further than just 2024, like, I personally am worried that they're going to like, attack the definition of mental health benefits because the way it's written now includes anything that's in the ICD or dsm, which includes gender dysphoria. And we know all of the things this administration is doing. So. So the best kept secret of parity is that it can be used to advocate for gender affirming care, which is not something I usually tell people in this political climate, but it's actually one of the only protections we still have. However, if that gets rolled back, we're all screwed. So I'm working with a couple of states right now, and hopefully Maryland will be one of them, to try and make sure that any references, at least to the definitions, preserve access to certain services that I want to preserve access to. So I think we're going to do a little cleanup of Maryland laws to make sure that our references, like, just either take out the reference altogether or, you know, only references the stuff that we, we feel safe about. So I think we're going to do a little cleanup this year. And I mentioned on our, on the thing that I want to do more of these like, secret shopper survey audit requirements. I just drafted some legislation for some folks in New Hampshire in order to do that and I, you know, flagged it for a couple of Maryland books. I was like, did I announce on a run with this this year? And a few people were like, yeah, we totally do. So we might try and run one of those bills. We'll see.

Okay. Yeah, that's interesting. I any. Anything on the slate, and maybe this isn't your area, but for protection with AI therapy and all of those things, those, those are alarming to a lot of us.

Yeah. So there, there was a bill that passed last year about the use of AI in health insurance. I think it might have been other types of insurance too, but. And had some like, pretty good protections in there. Like.

And that was Maryland.

Yeah.

How did I miss that?

Okay, but just in like health insurance, not in terms of like, providers or certain other things. I, we definitely testified on it, so I can find it somewhere. I want to say it's like 8:20, but I'm making that up now. So that one wasn't bad because my biggest fear about AI is that it's used to deny people care. Like if you want to use AI to like Approve my care faster. Go ahead. Please do. But I do not think it should ever be used to deny care because care should always be decided on an individualized basis. And I don't want a machine ever depriving someone, someone of something that they're entitled to. So that's always our caution. And there was a really good report, actually, that came out from a group of us who. Okay, now I'm getting super nerdy. I'm so sorry. But there's this group called the national association of Insurance Commissioners. So basically every state has an insurance commissioner. All of those people hang out together.

Yeah.

So there are like 45 of us that are consumer representatives to that group. So we just show up and like complain. But you know, everyone else who shows up and complain is like an insurance lobbyist. So better that there are some of us. Yeah, so we do like one funded report every year, sometimes two. And we did one just last year on AI and health insurance. And I think that was really powerful to see, like how it is being used to deny people care without like a real person reviewing it. So one of our recommendations was that that should not.

Yeah, I mean, I agree that that is concerning, but I'm also concerned that AI is recording sessions and that exists in the cloud somewhere and that all AI recording people I've talked to, that data is mined. And even if the actual recording is supposedly deleted, like we're trusting a company, an insurance company, to delete the recording. Right. But they're still selling the data. And then also, like, I just, I don't, I don't know, I just feel like there are so many concerns with training AI, Talk Spaces, with Amazon training AI to be a therapist. And you've probably seen the, the case in Florida where that didn't work out at all. Yeah, yeah, I just, it's, it's mind blowing. And to me, legislation can't even keep up with how quickly all of this is happening.

Yeah, I, I refuse to use any of the like, chatgpt stuff because I just don't know where my data is going to go and I don't know like what metadata they're gathering just by me, like having it open on my computer with something else at the same time. So. And even for the apps that don't use AI but are still like an app, the privacy protections don't exist because generally they're not like a healthcare entity. So they're not even subject to hipaa. So they'll say we comply with all privacy laws, which means they don't comply with any laws, because there are none. Right. Like, and people don't know this. People don't know that there are, like, no real privacy protections for, like, your phone app that's trying to help you quit smoking or, like, something like that. It's like, anyone and their mother now has that information. Or even if it says, we don't sell your data, that can change. Like, it just can change. Right.

That's my perspective, too. Well, a lot of work you do is. Well, right, But. But that's where I'm like, there has to be ways to strategically begin to continue to provide good care and protect people. There have to be ways.

I hope so. Especially because, like, human connection is so important for so much of, like, mental health care. And, like, as someone who literally saw my therapist this morning, it's just like, there's no equivalent to, like, being able to, like, connect with someone and build that trust and feel seen. And, like, that doesn't happen when you're talking to a computer.

I know, I know. Well, this has been lovely. So I thank you again. If there is anything that I can ever do to support you and your work, please seriously reach out. I would love to.

I will. I'll add you to my little parody listserv for Marilyn. I did a.

Yes. Amazing.

I'll let you know. Things pop, too.

Okay, sounds good. Well, have a great rest of your day.

Thank you. You too.

Okay, bye. Bye.